Acknowledgment: The author thanks Robert S. Kahn, MD, MPH, for his assistance and the Center for Health and Wellbeing at the Woodrow Wilson School of Public and International Affairs, Princeton University, for its financial support.

The full content of Annals is available to subscribers

To anyone delivering health care to adults in the United States, the impact of obesity on physical and emotional health is obvious. Obesity is often related to the pathophysiology of a patient's “chief complaint.” When it is not, the obesity is still likely to influence how the physician diagnoses and manages the patient's health concerns. Even those in practice for only a few years feel that more of their patients are obese now than before and that their patients are becoming obese at even younger ages. For these reasons, obesity is increasingly hard to ignore.

Obesity can generate complex emotions that complicate the physician–patient dialogue. Physicians do not like feeling unable to help their patients “cure” obesity (1). Though not well documented, it seems likely that more physicians themselves are also becoming obese. To assert the truth—that small and sustained imbalance in energy intake and expenditure leads to obesity—is of no more help to the obese patient than it is to the obese physician. There is much more to why we sit or move and why we do or do not eat. The pathway to obesity is a complex journey.